Key result
In pregnant women with heart disease, the need to change cardiac medication (OR 4.57), previous cardiac complications, and NYHA class III at the first prenatal visit were significant predictors of cardiovascular complications.
Cohort (n=132)
No
Odds Ratio: 4.57 (95% CI 1.84–11.35)
p-value: p=0.001
In pregnant Brazilian women with heart disease (predominantly rheumatic), the CARPREG index inaccurately estimated cardiovascular complication risk, highlighting the need for population-specific risk assessment.
Identified predictors may aid prenatal counseling in women with heart disease; leaves open validation of population-specific scores beyond CARPREG.
BACKGROUND: Heart disease in pregnancy is the leading cause of non- obstetric maternal death. Few Brazilian studies have assessed the impact of heart disease during pregnancy. OBJECTIVE: To determine the risk factors associated with cardiovascular and neonatal complications. METHODS: We evaluated 132 pregnant women with heart disease at a High-Risk Pregnancy outpatient clinic, from January 2005 to July 2010. Variables that could influence the maternal-fetal outcome were selected: age, parity, smoking, etiology and severity of the disease, previous cardiac complications, cyanosis, New York Heart Association (NYHA) functional class > II, left ventricular dysfunction/obstruction, arrhythmia, drug treatment change, time of prenatal care beginning and number of prenatal visits. The maternal-fetal risk index, Cardiac Disease in Pregnancy (CARPREG), was retrospectively calculated at the beginning of prenatal care, and patients were stratified in its three risk categories. RESULTS: Rheumatic heart disease was the most prevalent (62.12%). The most frequent complications were heart failure (11.36%) and arrhythmias (6.82%). Factors associated with cardiovascular complications on multivariate analysis were: drug treatment change (p = 0.009), previous cardiac complications (p = 0.013) and NYHA class III on the first prenatal visit (p = 0.041). The cardiovascular complication rates were 15.22% in CARPREG 0, 16.42% in CARPREG 1, and 42.11% in CARPREG > 1, differing from those estimated by the original index: 5%, 27% and 75%, respectively. This sample had 26.36% of prematurity. CONCLUSION: The cardiovascular complication risk factors in this population were drug treatment change, previous cardiac complications and NYHA class III at the beginning of prenatal care. The CARPREG index used in this sample composed mainly of patients with rheumatic heart disease overestimated the number of events in pregnant women classified as CARPREG 1 and > 1, and underestimated it in low-risk patients (CARPREG 0).
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Martins et al. (2016) conducted a cohort in Heart disease in pregnancy (n=132). Need to initiate or change cardiac medication vs. No change in cardiac medication was evaluated on Cardiovascular complications during pregnancy (OR 4.57, 95% CI 1.84-11.35, p=0.001). In pregnant women with heart disease, the need to change cardiac medication (OR 4.57), previous cardiac complications, and NYHA class III at the first prenatal visit were significant predictors of cardiovascular complications.
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